Speaking / Event Request Form

* indicates required

How did you hear about Ken Rohla *What are the proposed date(s) and time(s) for the event (Eastern Standard Time) *What is the interview length? Where is the venue for this event? *If in-person, specific event location: If online, what is the URL where this event will be posted? This will be a: *This event will be: If this is an interview, will Ken contact you, or will you contact Ken? If Ken is to contact you for the interview, what is the phone number, Skype address, etc. to use?If the interview has connection problems, is there a backup number/address to use, and if so, what is it?Please list any specific topic(s) you would like Ken to discuss. (We can provide a list of topics, some of which you may not be aware.)What is the name of the show/event host(s) whom Ken will be addressing on the show? *